Microneedling with Growth Factor Serum or PRP
Multiple channels are created into the dermis with tiny needles, and growth factors stimulate fibroblast activity to make collagen
Benefits: Decreases fine lines and pore size, decreases acne
How much collagen: just enough to prevent loss over time
Downtime: 1-2 days of redness
Cost: $-$$
Fractional Non-ablative laser (LaseMD Ultra, Moxie)
Fractional non-ablative laser resurfaces the skin and heats the dermis to stimulate collagen
Benefits: Decreases fine lines, wrinkles and pores, decreases pigment/sun spots
How much collagen: just enough to prevent loss over time
Downtime: 1-2 days of redness, 1 day of mild swelling, 3-7 days of sandpaper skin (not visible)
Cost: $$ - $$$
Surface Heating with Radiofrequency and/or Ultrasound (Exilis Ultra, Ultherapy, Thermage)
RF and/or Ultrasound heat the dermis and stimulate collagen and elastin
Benefits: Thickens and tightens skin, decreases wrinkles and sagging skin
How much collagen: enough to tighten the skin somewhat
Downtime: none
Cost: $$ - $$$$
RF Microneedling (Genius, Profound, Secret, Virtue)
Combines microneedles and RF to cause coagulation and massive collagen remodeling of the dermis, also stimulates elastin production
Benefits: Most powerful tool to thicken and tighten skin, decreases wrinkles and sagginess, reverses acne scarring
Safe on any skin type
How much collagen: abundant stimulation of collagen, maximum skin tightening
Downtime: 1-2 days of swelling, 3-5 days of redness
Cost: $$$
Fractional Ablative Laser (CO2 and Erbium Laser Resurfacing)
Not recommended in the Medical Spa setting
For use by Experienced Skin Specialists only
How much collagen: enough to tighten the skin somewhat. Purpose is more focused on resurfacing
2 Weeks Severe Downtime
Higher Risks of Hyper- and Hypo-pigmentation
Higher risks of scarring
$$$$
What are my specific recommendations? My favorite regimen-- what I do for myself-- is to combine RF Microneedling (as of this writing Genius is my device of choice) combined with laser resurfacing with LaseMD Ultra. I did 5 treatments the year I turned 50 and I do about one every six months for maintenance. I have minimal downtime and better skin than I did a decade ago.
As you can see, I am not a fan of using more aggressive lasers in the med spa setting. We are helping people to preserve their skin and bring out their natural beauty. We are NOT fixing congenital nevi or disfigurement from trauma. The aggressive lasers carry too much risk of adverse events to be justified for use in Med Spas. Do some places use them? Absolutely. And they can produce excellent results. However, given that we are starting with perfectly healthy skin, nothing is worth any permanent harm. If you are an ideal candidate for one of these laser treatments and you are lucky enough to suffer no untoward results, then you will see fantastic results after fewer treatments than by using a non-ablative laser. Are the risks worth it? I believe the answer is yes when you are trying to restore the skin after disfigurement. For me, the answer is no for simple rejuvenation.
What about Fully Ablative Laser resurfacing? The first fully ablative CO2 laser was developed in the 1970’s and was for a long time the standard, as it was the only thing available to resurface the skin. Fractional lasers treat only a fraction of the skin surface, leaving the rest intact. Fractional treat the skin in tiny columns. Fully Ablative lasers burn all the skin surface off. They are much more dangerous, and fell out of favor many years ago. They can occasionally be used (best in the academic setting) to treat very difficult cases. These are not generally in use in any spa.
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